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When metals compete: a case of copper-deficiency myeloneuropathy and anemia

Nature Clinical Practice Neurology volume 5, pages 106–111 (2009)Cite this article

Abstract

Background A 47-year-old woman with an otherwise unremarkable medical history was referred to the multiple sclerosis clinic by her primary neurologist for evaluation of a 2–3 year history of progressive knee and back pain, weakness, paresthesias, sensory loss, ataxia, and falls. During the same period, she had received blood transfusions for unexplained anemia and leukopenia. She had been wearing dentures for many years.

Investigations Physical examination, neurological examinations (assessments of reflexes, gait, proprioception, and sensitivity to temperature, pinprick and vibration), neurophysiological studies (visual and brainstem somatosensory evoked potentials, nerve conduction studies and electromyography), T2-weighted MRI of the brain and spine, cerebrospinal fluid analysis and serum evaluations.

Diagnosis Myeloneuropathy and anemia due to copper deficiency, secondary to zinc overload associated with long-term use of denture cream with a high zinc content.

Management Change to a low-zinc denture cream and oral copper replacement.

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Figure 1: T2-weighted MRI scans of the patient's cervical and upper thoracic spine at diagnosis of copper-deficiency myeloneuropathy and after 5 months of treatment.

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Acknowledgements

We thank the patient mentioned in this article for giving written permission for the presentation of her medical history and case. Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. At the time of writing, RI Spain was a Neuroimmunology Fellow at Thomas Jefferson University. She is currently a Senior Instructor at the Multiple Sclerosis Center of Oregon, Oregon Health Sciences University, Portland, OR.,

    Rebecca I Spain

  2. and EA De Sousa is an Assistant Professor in the Division of Neuromuscular Disorders, TP Leist is an Associate Professor of Neurology and Director of the Comprehensive Multiple Sclerosis Center, both at Thomas Jefferson University, PA, USA.,

    Thomas P Leist & Eduardo A De Sousa

Authors
  1. Rebecca I Spain
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  2. Thomas P Leist
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  3. Eduardo A De Sousa
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Correspondence to Rebecca I Spain.

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Spain, R., Leist, T. & De Sousa, E. When metals compete: a case of copper-deficiency myeloneuropathy and anemia. Nat Rev Neurol 5, 106–111 (2009). https://doi.org/10.1038/ncpneuro1008

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